Showing papers on "Nosocomial infection control published in 1997"

Wound Tissue Oxygen Tension Predicts the Risk of Wound Infection in Surgical Patients

Abstract: Objective: To test the hypothesis that subcutaneous wound oxygen tension (PsqO2) has a predictive relation to the development of wound infection in surgical patients. Design: A noninterventional, prospective study. Setting: A university department of surgery. Patients: One hundred thirty operative general surgical patients at notable risk of infection as predicted by an anticipated Study on the Effect of Nosocomial Infection Control (SENIC) score of 1 or greater. Outcome Measures: PsqO2was measured perioperatively. Its relation to the subsequent incidence of surgical wound infection was then determined and compared with the SENIC score as a criterion standard. Results: Although the SENIC score and PsqO2are inversely correlated, PsqO2 is the stronger predictor of infection. Low PsqO2identified patients at risk and concentrated them in a cohort that was about half the size of that identified by the SENIC score. Conclusions: Subcutaneous perfusion and oxygenation are important components of immunity to wound infections. The SENIC score identifies systemic physiological variables that are important to the development of wound infection. Nevertheless, PsqO2More-he more powerful predictor of wound infection. Moreover, PPsqOcan be manipulated by available clinical means, and thus may direct interventions to prevent infection. Arch Surg. 1997;132:997-1004

Nosocomial infections in surgical patients : Comparison of two measures of intrinsic patient risk

Abstract: OBJECTIVE To compare, in subjects undergoing general surgery, two measures of intrinsic patients risk for nosocomial infection: the Study on the Efficacy of Nosocomial Infection Control (SENIC) index and the National Nosocomial Infection Surveillance (NNIS) System index. DESIGN Prospective cohort study, with follow-up for 1 month after hospital discharge. SETTING The general surgery service of a tertiary hospital. MAIN OUTCOME MEASURE Surgical-site infection. PATIENTS 1,483 subjects aged 10 to 92 years. RESULTS During follow-up, 155 patients developed nosocomial infection, yielding a cumulative incidence of 10.5%. The NNIS index showed a linear trend with both crude and adjusted (for SENIC index) rates of surgical-wound infection. The SENIC index did not exhibit any linear trend with adjusted (for NNIS index) rates of surgical-wound infection. To delineate whether the SENIC index added explanatory information to the NNIS index (or vice versa), we regressed each variable on the other. Logistic regression analyses confirmed the results of stratified analysis: residuals of the NNIS index added discriminating ability to the SENIC index, whereas residuals of the SENIC index did not improve the predictive power of the NNIS index. CONCLUSIONS The NNIS index had a better ability than the SENIC index for discriminating and predicting risk of surgical-wound infection.

The challenge of postoperative infections: does the surgeon make a difference?

Abstract: Postoperative infections remain a challenge in many surgical procedures despite improved surgical technique and powerful antibiotics. The number of sepsis cases has tripled from 1979 to 1992 due to increased invasive procedures in older and immune-suppressed patients. Increasingly, in recent years, outbreaks of resistant pathogens have been published, provoking the question of how postoperative infections and resistant pathogens should be dealt with. Wound classification and risk stratification were developed to identify patients at risk for postoperative infection. However, other important intrinsic factors of the patient were not included, and further attempts have been made to increase sensitivity and specificity (eg, Study on the Efficacy of Nosocomial Infection Control project, National Nosocomial Infection Surveillance System score); the American Society of Anesthesiologists preoperative assessment score and the operation duration for specific procedures were introduced into the system as risk stratifiers. Advances in immunology have identified new ways in which the surgeon can moderate the immune response (eg, hemorrhage and blood transfusion-induced immune suppression). The increased rate of resistance in enterococci and staphylococci has refocused attention on infection control in surgery. However, there are recent reports from both sides of the Atlantic indicating that guidelines for infection control and antibiotic policy have not become reflected in standard procedures in many hospitals. New antibiotics may be developed, but resistance soon may follow. Sound techniques in surgery, with careful infection control and antibiotic policies, may be the only strategy to prevent further increases in resistance of pathogens in postoperative infections.

Epidemiología de las infecciones nosocomiales en un hospital de segundo nivel

Abstract: Objective. To determine the incidence, specific rates, areas of greatest risk and causal agents of nosocomial infections at the Hospital General de Durango, of the Secretaria de Salud, Mexico. Material and methods. Prospective study of nosocomial infection vigilance during one year including all patients discharged during this period. Results. An overall rate of 9 infections per 100 discharged patients was found, the higher specific rates were in the areas of intensive pediatric care and births and the lowest were in the surgery, pediatric and gynecology and obstetrics departments. Infections were most frequent in urinary tract and surgical wounds as well as pneumonia among adults; among children, the most frequent were bacteremias and an epidemic outbreak with predominating Serratia marscecens was observed. Most patients presented one only infectious process and E. coli, Klebsiella and Enterobacter sp. were the most frequently isolated microorganisms. Conclusions. The nosocomial infection rate observed in this study is higher than the average in Mexico for similar institutions. The most affected areas were those of critical patients and new births with urinary tract and surgical wound infections, and pneumonia, and the most frequent causal agents were enteric Gram-negative bacilli. These findings suggest guide lines for the design of a nosocomial infection control program, adjusted to the particular features of each institution.

Epidemiology of nosocomial infections in a second level hospital

Abstract: OBJECTIVE To determine the incidence, specific rates, areas of greatest risk and causal agents of nosocomial infections at the Hospital General de Durango, of the Secretaria de Salud, Mexico. MATERIAL AND METHODS Prospective study of nosocomial infection vigilance during one year including all patients discharged during this period. RESULTS An overall rate of 9 infections per 100 discharged patients was found, the higher specific rates were in the areas of intensive pediatric care and births and the lowest were in the surgery, pediatric and gynecology and obstetrics departments. Infections were most frequent in urinary tract and surgical wounds as well as pneumonia among adults; among children, the most frequent were bacteremias and an epidemic outbreak with predominating Serratia marscecens was observed. Most patients presented one only infectious process and E coli, Klebsiello and Enterobacter sp. were the most frequently isolated microorganisms. CONCLUSIONS The nosocomial infection rate observed in this study is higher than the average in Mexico for similar institutions. The most affected areas were those of critical patients and new births with urinary tract and surgical wound infections, and pneumonia, and the most frequent causal agents were enteric Gram-negative bacilli. These findings suggest guide lines for the design of a nosocomial infection control program, adjusted to the particular features of each institution.